In patients with schizophrenia taking antipsychotic drugs, an early diffuse fibro-inflammatory myocardial process independent of established cardiovascular disease (CVD)-risk factors may contribute to the excess of CV mortality associated with schizophrenia, a new study found. Researchers sought to determine there is evidence of cardiac fibrosis and/or inflammation using cardiac MRI in medicated patients with schizophrenia vs matched healthy controls. Among the details:
- 31 participants (14 patients and 17 controls) underwent cardiac MRI assessing myocardial markers of fibrosis/inflammation, indexed by native myocardial T1 time, and cardiac structure.
- Compared with controls, native myocardial T1 was significantly longer in patients with schizophrenia.
- Patients had significantly lower left ventricular mass, and lower left/right ventricular end-diastolic and stroke volumes.
- There were no significant differences in left/right end-systolic volumes and ejection fractions between groups.
Pillinger T, et al. Cardiac structure and function in patients with schizophrenia taking antipsychotic drugs: An MRI study. [Published online ahead of print June 7, 2019]. Transl Psychiatry. doi: 10.1038/s41398-019-0502-x.
People with schizophrenia typically lose a decade or more of life compared to the general population with most premature deaths being due to complications of cardiovascular disease (CVD) such as heart attack and stroke. What is less clear is whether this increased cardiovascular burden is related to some intrinsic, perhaps inflammation-mediated abnormality of the schizophrenia syndrome, a result of lifestyle factors common in people with schizophrenia such as higher rates of smoking and sedentary lifestyle, or if they are related to longer-term effects of antipsychotic drugs. Findings of this study, which used cardiac MRI to examine myocardial markers of fibrosis/inflammation in a sample with schizophrenia suggested an early diffuse fibro-inflammatory myocardial process. While study methods do not permit conclusions regarding possible drug-related effects, results can help inform research on future treatments that might be able to minimize progressive alterations in myocardial tissue and ultimately reduce the cardiovascular burden seen in patients with schizophrenia. —Martha Sajatovic, MD, Professor of Psychiatry and of Neurology; Willard Brown Chair in Neurological Outcomes Research; Director, Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center; Case Western Reserve University School of Medicine.